Lali’s Law Improves Naloxone Access and Expands Insurance Coverage for Substance Use Disorder Services in Illinois

posted on Wed, Oct 14 2015 11:18 am by Derek Carr

The nationwide opioid overdose epidemic has been well documented on the Network’s blog. The epidemic strikes people from all parts of the country, but some areas have been particularly hard hit. According to a recent report from Roosevelt University, Chicago ranks first in the nation in the number of emergency department mentions for heroin, ahead of both Boston and New York. Perhaps not coincidentally, the report found that between 2007 and 2012, Illinois also ranked first in decreases in treatment capacity.

On September 9, the Illinois General Assembly took an important step in reversing these trends by passing Lali’s Law, a comprehensive reform bill that takes a holistic approach in addressing the opioid epidemic. The law was named in honor of Alex "Lali" Laliberte, a young man who died in 2008 from an overdose involving heroin and other drugs. Two of the most important changes made by the law involve increased access to the opioid antidote naloxone and insurance reforms to expand coverage for naloxone and substance use disorder (SUD) treatment.

With the signing of the law, Illinois becomes the sixth state to permit pharmacists to dispense naloxone under a statewide protocol. Under this provision, trained pharmacists will be permitted to dispense naloxone to any person who comes to the pharmacy, even if they do not have a prescription for the medication. Because pharmacists are often more accessible than physicians and other traditional clinical providers, this change will make it more likely that naloxone will be available when and where it is needed.

The law also builds upon the state’s existing naloxone access law by explicitly authorizing certain medical professionals to prescribe the medication not only to their own patients, but also to family members, friends, and others who are likely to be in a position to assist in the event of an overdose. Further, the law provides criminal immunity for health care professionals who prescribe and dispense naloxone pursuant to the law, and protection from civil liability for both pharmacists who dispense naloxone and laypersons who administer naloxone in good faith.

Finally, Lali’s Law improves first responder naloxone access by requiring most state and local agencies employing law enforcement officers or firefighters, as well as public and private EMS agencies, to possess naloxone, establish policies for its administration, and provide training on its use. It also permits school nurses and other trained personnel to administer naloxone to students and authorizes the use of some civil forfeiture funds to purchase the medication.

Lack of funding has been a consistent barrier to naloxone and evidence-based SUD treatment. Lali’s law takes steps to ensure that both will be available by mandating insurance coverage for naloxone and many evidence-based SUD treatments.

Under the law, any individual or group accident or health insurance plan amended, delivered, issued, or renewed after September 9, 2015, which otherwise provides prescription drug coverage, including those purchased on the state’s Affordable Care Act Marketplace, must provide coverage for at least one opioid antagonist like naloxone. These plans must also provide coverage for both medically necessary short-term acute and longer-term clinical stabilization SUD treatment services. Moreover, the state Medicaid program will cover both all FDA approved opioid antagonists and, without any preauthorization requirements, all FDA approved forms of medication-assisted treatment (MAT) prescribed for the treatment of alcohol or opioid dependence.

Finally, the law will implement a public education program to increase awareness about the state’s overdose Good Samaritan law, which encourages overdose bystanders to summon medical assistance by providing protection against criminal prosecution for certain controlled substance possession offenses, increase access to drug courts that promote treatment over incarceration, and impose new data reporting requirements that will allow for better research on the overdose epidemic.

This post was developed by Derek Carr, J.D., Legal Fellow at the Network for Public Health Law – Southeastern Region at the National Health Law Program (NHeLP).

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.